Provider Demographics
NPI:1720757958
Name:BOWIE, RAQUEL MONIQUE
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MONIQUE
Last Name:BOWIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10265
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0265
Mailing Address - Country:US
Mailing Address - Phone:480-387-8212
Mailing Address - Fax:
Practice Address - Street 1:2344 W APOLLO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5333
Practice Address - Country:US
Practice Address - Phone:480-387-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health